Study On The Prognostic Judgment Of Exhaled Carbon Dioxide During Cardiopulmonary Resuscitation

Objective:In this study,ETC02 was used as indicators to predict the prognosis of cardiopulmonary resuscitation.In order to seek simple and highly specific cardiopulmonary resuscitation termination indicators.Methods:Adult non-invasive in-hospital cardiopulmonary resuscitation patients who completed resuscitation.The database were selected and their baseline and resuscitation outcomes were recorded.Then screened for patients who correctly recorded ETC02 values within 30 minutes of resuscitation.Recorded every minute ETC02 value within 30 minutes of resuscitation.The selected patients were divided into a ROSC group and a non-ROSC group,and analyzed whether there was a difference in the ETC02 level between the two groups.If there was a difference,to calculate the best cut-off value for ETC02 between both groups.Then took ETC02 below the optimal cut-off value at different time durations as criterion to predict resuscitation prognosis,and the sensitivity,specificity,PPV and 95%CI,NPV and 95%CI were calculated.,Results:The first part of this study screened 212 adult non-traumatic in-hospital cardiac arrest patients from the database.To meet the ETC02 requirement,120 patients were finally selected.The overall ROSC rate was 41.7%and the overall survival rate was 5.8%.There was no difference in baseline between ROSC and non-ROSC groups,and there was a significant difference of ETC02 between the two groups.The best cut-off point for the prognosis of resuscitation with a single ETC02 value was 10.5 mmHg.Taking continuous ETCO2≤10mmHg as the criterion for predicting the prognosis of resuscitation.The sensitivity was reduced from the standard 58.2%of the single ETC02 value to 28.2%of the criterion of ETCO2≤10mmHg for 10 consecutive minutes.The specificity of the outcome was judged to rise from the standard 39.4%for the single ETC02 value to 100%for the 10-minute ETCO2≤lOmmHg.The corresponding false positive dropped from 60,6%to 0%;the false negative increased from 41.8%to 71.8%;the PPV rose from 40.0%(95%CI 37.9-42.2%)to 100%(95%CI 97.8-100%);NPV from 57.5(95%CI 54.9-60.1)fell to 34.2(31.0-37.6).Conclusions:This study explored the prognosis of cardiopulmonary resuscitation by monitoring exhaled carbon dioxide levels.Clinical data analysis found that(1)the value of ETC02 was associated with the prognosis of cardiopulmonary resuscitation in adult non-traumatic in-hospital cardiac arrest patients;(2)the continuous monitoring of ETC02 values can more accurately determine the prognosis of cardiopulmonary resuscitation than single ETC02 values;(3)The single ETC02 values was not a good index to predict the prognosis of cardiopulmonary resuscitation;(4)The continuous ETOC2≤10mmHg had better specificity in predicting the recovery outcome and the shortest reasonable monitoring time possible was 10 minutes;(5)The continuous 10 minutes.ETC02≤1OmmHg can be used as one of the indicators to judge the termination of resuscitation.Objective:In this study,MVCO2 was used as indicators to predict the prognosis of cardiopulmonary resuscitation.In order to seek simple and highly specific cardiopulmonary resuscitation termination indicators.Methods:Small pigs were used as test animals.A resuscitation model was established.The ETCO2,MVCO2,ALP,MAP,ventilation frequency,and minute ventilation during cardiopulmonary resuscitation were recorded.Arterial blood gas and central venous blood gas were examined in the first 5 minutes of resuscitation,and partial pressure of carbon dioxide(Pco2)was recorded.Electrical defibrillation was given 6 minutes after resuscitation and it was recorded if defibrillation was successful.Comparison of ETCO2,MVCO2,ALP and MAP between animals with defibrillation success group and unsuccessful defibrillation group.Is there a correlation between MVCO2 and ETCO2,ALP,MAP.Results:10 pigs were used in this study.6 defibrillated successful,and 4 defibrillated failed.There was no difference between the two groups in the main parameters before resuscitation.MVCO2,ETCO2,ALP,and MAP were statistically different between the two groups.The receiver operating characteristic(ROC)curve of MVCO2 predictive defibrillation results showed that the area under the ROC curve was 0.981.The optimal cut-off value was calculated to be 123.5mmHg,with the sensitivity of 97.2%and the specificity of 91.7%.The area under the ROC curve of ETCO2 was 0.962.The optimal cut-off value was calculated to be 15.5mmHg,with the sensitivity of 77.8%and the specificity of 95.8%.The area under the ROC curve of ALP was 0.843.The optimal cut-off value was 7.5mmHg,the sensitivity was 83.3%,and the specificity was 75.0%.The area under the ROC curve of MAP was 0.912.The optimal cut-point value was calculated to be 27.5 mmHg,the sensitivity was 86.1%,and the specificity was 83.3%.There was a correlation between MVCO2 and ETCO2,ALP,and MAP values,all Pearson test P<0.05.Multivariate logistic regression models suggested that MVCO2 index was an important factor affecting the prognosis of resuscitation.Conclusions:(1)The value of MVCO2 in the successful defibrillation group was higher than that in the defibrillation failure group,and the best cut-off value for distinguishing was 123.5 ml/min.(2)MVCO2 are related to ETCO2,ALP,and MAP during cardiopulmonary resuscitation.(3)MVCO2 had better ability to predict resuscitation prognosis than ETCO2,ALP and MAP as a predictor of prognosis for resuscitation.(4)MVCO2 was an independent risk factor that affects the prognosis of cardiopulmonary resuscitation.